Health: there are 5 types of diabetes and not 2, according to doctors

Until then, diabetes was classified into two types, type 1 or “low-fat diabetes” and type 2 or fatty diabetes. ”However, diabetes turns out to be a much more heterogeneous disease. ” a powerful tool for individualizing risks and, ultimately, the most appropriate treatment regimen, right from the diagnosis.

The results of a study published in the Lancet 1^er March 2018 report 5 types of diabetes instead of 2, and the arguments are rather “very consistent” with what diabetologists have been observing and discussing for several years according to what Professor Serge Halimi, diabetologist in Grenoble, told us .

A cross-retrospective analysis

Researchers in the Swedish cohort “All New Diabetics in Scania” analyzed the fate of 8,980 newly diagnosed diabetics. They looked at 6 parameters that appeared to be discriminating (anti-glutamate decarboxylase antibody, age at diagnosis, BMI, glycated hemoglobin, insulin resistance and function of pancreatic insulin-secreting beta cells).

New from @TheLancetEndo: Researchers offers five distinct types of adult-onset #diabetes https://t.co/tuA3ojOrE4 pic.twitter.com/mskSMxFb6c

– The Lancet (@TheLancet) March 2, 2018

The results of this study were then tested and validated in three other cohorts independent of the first and including diabetic patients (the Scania Diabetes Registry – n = 1466, All New Diabetics in Uppsala – n = 844 and Diabetes Registry Vaasa – n = 3485) and the results overlap.

According to this analysis, there are now 5 types of diabetes, 3 of which are severe and the cause of the main complications.

3 types of severe diabetes

The first group (“Group 1”) is “severe insulin-dependent diabetes” which concerns patients with a low body mass index, an insulin deficit and antibodies indicating an autoimmune origin of the disease. It develops in young people and is close to type 1 diabetes as it is currently defined.

Another severe diabetes is “Group 2”: the patients have “severe insulin-deficient diabetes”, they are similar to patients in group 1, but their immune system is not involved in the disease, this is the main difference. These patients have a higher risk of severe retinopathy according to the researchers.

A third category of severe diabetes is “Group 3” with “severe insulin-resistant diabetes”: the patients are clearly overweight or have obesity and their cells are not very sensitive to insulin, which causes glucose to enter them. wrong. It is these patients who are most exposed to hepatic steatosis and diabetic nephropathy.

2 types of more mild diabetes

There are milder forms of diabetes.
First, “Group 4”, the most frequent, which corresponds to overweight patients suffering from mild diabetes without real insulin resistance.

The last form is “Group 5” which corresponds to “mild age-related diabetes” and which corresponds to “insulin-senescence” or aging of the pancreas.

A new classification for better processing

The researchers explain that this new classification into five types makes it possible to highlight a different progression of the pathology and a differentiated risk of diabetic complications. Group 3, the most insulin-resistant diabetics have a significantly higher risk of diabetic kidney disease than in groups 4 and 5. Group 2, insulin-deficient, has the highest risk of retinopathy.

This classification therefore shows a clear difference in prognosis between the first 3 groups and the last 2. The therapeutic implications are obvious and encourage more intensive treatment of the diabetes of the first 3 groups, knowing that it is the insulin which will be privileged in the first 2 and that it is the drugs allowing to fight against the insulin resistance which will be. privileged in Group 3.

According to Professor Serge Halimi (Grenoble), this would be a first step towards “precision medicine” in diabetology.